Menstruation is a natural and healthy reproductive process. Yet, it is often subject to taboos and rarely talked about in public. It is high time we break the stigma and make menstrual justice a reality for all menstruators, everywhere.
Approximately 1.8 billion people are on their periods every month worldwide. This means that at a given point each day, 800 million people are menstruating. Nevertheless, menstruation is often subject to various cultural taboos and rarely talked about in public. In the satirical 1978 essay If Men Could Menstruate, feminist activist and journalist Gloria Steinem, therefore, imagines a world where menstruation would be celebrated and openly discussed. By flipping the script, she shows how menstruation is stigmatized merely because of its association with women’s bodies.
What are the consequences of such stigma in menstruators’ lives around the world? Moreover, why is it so important to break it?
Menstruation as Physiology, Culture and Lived Experience
On average, menstruators will spend a total of seven years during their lifetime bleeding. The quantity of blood that a person loses during each period varies but typically comprises around three tablespoons. For some heavy bleeders, me included, it can sure feel as much more, however. This is especially the case on those days when you bleed through. Truth be told, periods can be bloody messy, painful, and burdensome to handle. For some reason, they also almost always seem to come at the most inconvenient time, irrespective of the average menstrual cycle of 28ish days.
A sudden onset of heavy menstrual bleeding is also a common occurrence during perimenopause. This could also be the reason why I suddenly found myself squatting with my pants around my knees, desperately trying to insert a tampon at the edge of a rice paddy while on fieldwork in Madagascar during the summer of 2017.
As part of a study on fertility control, I was accompanying a mobile family planning clinic that offers contraception free of charge to women living in poverty in a village on the outskirts of Madagascar’s capital city of Antananarivo. Most of the village was accessible by foot only and consisted of brick houses connected by narrow dirt roads across various types of fields and rice paddies.
While I was walking with the clinic’s staff to inform the women we met about the mobile clinic’s family planning services, I got my period. While I had fortunately had the foresight to bring along my emergency period purse, there was no public toilet anywhere in sight. At that point, I was far more concerned about hiding any visible stains than adhering to menstrual hygiene precautions. Besides, how was I supposed to wash my hands without water, let alone soap?
Later, one of my key collaborators in the field, a midwife, allowed me to use her outdoor toilet. While there was no toilet paper or water available there either, some old torn-up newspapers were sitting next to the toilet. There was also a bucket where people had thrown away the newspapers after wiping themselves. To prevent the next person from seeing my used and bloody tampon, I carefully wrapped it up before discarding it in the bucket.
Menstruation is a normal, healthy, biological process. It is also entirely out of menstruators’ control. Yet, on both occasions, I never told anyone that I got my period. I also tried to keep any signs that I was menstruating out of sight from others.
Menstruation is a normal, healthy, biological process. It is also entirely out of menstruators’ control. Yet, on both occasions, I never told anyone that I got my period. I also tried to keep any signs that I was menstruating out of sight from others.
At the same time, menstruation seemed to be a recurring theme in the research project that had brought me to Madagascar in the first place. During group discussions with students at the University of Antananarivo about their views on contraception, both female and male students expressed concerns about hormonal birth control that could cause them or their partners to cease to menstruate.
They told me that they thought it was unnatural for menstrual blood to “remain” in the body and worried that if it was not “cleaned out of the womb” every month, it could produce a blockage of the reproductive system and, in turn, lead to infertility. Moreover, since so many students preferred natural methods of contraception, menstruation was central to the moral control of both their own and other’s sexual behaviour. It was, for example, typical for mothers to check female students’ towels for blood stains after showering to ensure that their daughters were not pregnant. Couples also often monitored menstrual cycles together to try to avoid an unwanted pregnancy.
The importance that these students placed on menstruation intrigued me. Menstruation is the body’s way of shedding the uterine lining it makes every month in preparation for a possible pregnancy. Hormonal birth control stops this process from happening, meaning that there is nothing to bleed out. Nonetheless, these students, some of whom studied medicine, were convinced that a period was essentially a necessary cleansing process. This also resembled how abortion patients described manual vacuum aspirations (MVA). MVA is a surgical procedure to induce abortions, which the Malagasy women I interviewed often simply referred to as “getting their periods back”.
Menstrual taboos: Purity and Impurity
For the first time in my menstruating life, I started to think about periods beyond my own uncomfortable bodily experience with them. How do menstruators around the world deal with their periods, and how do they perceive them?
Before my fieldwork in Madagascar, my interest in, and knowledge about, periods, had primarily been limited to their biological function in reproduction. I considered periods as a necessary nuisance, and menstrual cramps as something I had to power through.
To try to understand why the Malagasy students thought of menstruation as a cleansing process, I therefore decided to reread Mary Douglas’s (1966) seminal book Purity and Danger: An Analysis of Concepts of Pollution and Taboo. Douglas (1966) argues that in crossing the boundaries between bodies’ insides and outsides, bodily fluids such as menstrual blood are often conceived of as “matter out of place”. This suggests that menstrual blood, which is commonly perceived as belonging inside of the body, becomes taboo once it is no longer in its place of origin.
In Madagascar, menstrual blood was primarily considered problematic if it remained inside of the body, however. Then again, menstrual taboos can vary across the world. In some places, menarche (the onset of menstruation) is celebrated as an important rite of passage (Buckley and Gottlieb 1998). Nevertheless, menstrual blood and its management are more frequently perceived as taboo.
Notions of what is considered clean or dirty, pure or impure, are not about hygiene but rather concern cultural conceptualizations of the body (Douglas 1966). In many cases, menstrual blood therefore requires specific purifying measures to rid it of its ostensibly polluting qualities. For example, in rural parts of Western Nepal, menstruating girls and women are considered impure and hence untouchable. As a result, they are segregated from their families and sleep in small sheds or outbuildings or so-called menstrual huts (chaupadi) while on their periods.
Practicing chaupadi also means that the girls are unable to go to school while menstruating. Within health and development policy, menstruation is, in fact, considered one of the main reasons for girls’ school absenteeism in low-income countries in the Global South. To resolve this, menstrual health and hygiene management (MHHM) initiatives, especially those with a focus on development aid, have placed great emphasis on the distribution of menstrual products to “keep girls in school”.
Period Poverty and Stigma
MHHM was developed from the well-established water, sanitation, and hygiene sector (WASH). Menstruation has thus primarily been addressed as an issue of concern to public health. Policies catering to menstrual needs have mainly focused on improving tangible and material outcomes, such as the provision of menstrual products.
Having access to menstrual products to handle your period is essential. Having insufficient access to care for your body while menstruating is referred to as period poverty. But is the lack of menstrual products really what keeps girls out of school ? Girls and women have always managed their menstrual flow somehow.
In her book, The Managed Body: Developing Girls and Menstrual Health in the Global South (2019), critical menstruation studies scholar Chris Bobel (2019) claims that there is hardly any research that can establish a causal link between lack of menstrual products and girls dropping out of school. The biggest challenges related to menstruation and girls’ school absenteeism are rather insufficient access to adequate sanitary and hygiene facilities such as private toilets, menstrual pain, and menstrual taboos.
Distributing menstrual materials has, therefore, been criticized as a quick fix that draws attention away from what the girls really need, including in the long run. Moreover, Bobel (2019) claims that the discourses underpinning the MHHM movement not only oversimplify but also “reinforces the Western imaginary of the Global South” (Bobel 2019:7). “Traditional” menstrual care products such as cloth are presented as unhygienic and deficient, while Western-style or so-called modern alternatives such as single-use pads, tampons, or menstrual cups are presented as the solution.
By perceiving menstruation in the Global South as a “hygienic crisis”, Bobel (2019) argues that MHHM inadvertently contributes toward reproducing rather than dismantling menstrual stigma. While its manifestations vary around the world, menstrual stigma is universal. It is the reason why so many of us feel ashamed and embarrassed when we bleed through or why we smuggle tampons to a public toilet up our sleeves and cover used ones in toilet paper. It also renders menstruation invisible in public, which can lead to a lack of understanding or misconceptions about menstruation. Many menstruators do not know what periods entail or what to expect when reaching menarche.
A Call for Menstrual Justice
Menstrual health refers to “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle” (The Global Menstrual Collective 2021). To stay healthy but also to withstand and contest stigma, increasing knowledge about menstruation through education is therefore crucial. While the distribution of menstrual materials and the removal of the tampon tax helps to combat period poverty, it is not enough to remove the stigma. Menstruation is about so much more than the managing (or hiding) of blood. It is a fundamental issue that “unites the personal and the political, the intimate and the public, and the physiological and the socio-cultural”.
To Steinem, and feminists ever since, the personal is political. So are periods. Over the last decade, grassroots menstrual activists, notably from the Global South, have therefore relentlessly advocated for the inclusion of menstruation in health, education, and gender equality agendas. Menstrual health has finally been pushed into the public eye. Moreover, menstrual stigma is increasingly identified as the underlying obstacle to the realization of human rights. Hopefully, this will also entail equitable and sustainable solutions that cater to all menstruators’ needs, everywhere.
I reached menarche at age 12. A few days after this article is published, I will turn 46, meaning I am closing in on menopause. It has thus taken me around 34 years, 408 periods and 1224 tablespoons of blood to finally start talking about menstruation openly and without shame in public. I urge you not to make the same mistake as me, and instead speak up about menstrual stigma sooner rather than later. Change requires collective action, and it is high time we make menstrual justice a reality for all.
Works cited:
Bobel, Chris 2019. The Managed Body: Developing Girls and Menstrual Health in the Global South. Cham: Palgrave Macmillan.
Buckley, Thomas and Alma Gottlieb (eds.) 1998. Blood Magic: The Anthropology of Menstruation. London: University of California Press.
Douglas, Mary 1966. Purity and Danger: An Analysis of Concepts of Pollution and Taboo. New York: Routledge & Kegan Paul.
Article cover art by vulvani.com
